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Protect Your Spa From Risk

Jesse Cormier February 2011 issue of Skin Inc. magazine
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Most have heard of Murphy’s Law—if anything can go wrong, it will go wrong. This bit of humor serves as a reminder that no matter how careful you are, the potential is always there for something to go awry, even if it’s not as bad as pessimistic old Murphy predicted. The expression that may be more applicable to skin care is: “When it comes to risk, business is brisk.”

It isn’t necessarily a poor reflection on you for something to go wrong in your treatment room. The majority of skin care claims come from people who have never made a claim and likely never will again. Most, however, find one claim to be plenty, even with appropriate insurance and a satisfactory outcome. It’s nobody’s idea of fun.

Common and uncommon claims

For example, a ruined wedding—if you caused a burn or peeling on a bride—is one nightmarish scenario. Yet, the most frequent claims are rather mundane and include the following:

Chemical exfoliation. A chemical exfoliation that leads to scarring and hyperpigmentation.

Intense pulsed light (IPL). Machine malfunctions, inadequate training and incorrect application.

Product reactions. Failure to heed contraindications, allergic reactions, burns due to improperly mixed or applied product, or inadequate instructions for home care.

Waxing. Irritation and blisters, as well as lifting and tearing of skin that can lead to scarring.

Although these are run-of-the-mill, some stranger occurrences have led to claims, as well: A steamer that malfunctioned and sprayed scalding water on the client; a heavy magnifying glass that was dropped and injured a client’s eye; or a collapsing table that fell due to loosened bolts, causing the client to hit her head on a radiator, requiring stitches and amounting to more than $10,000. Taking the cake, however, is the story of an esthetician who lit a candle so she could continue a treatment after the spa’s power suddenly lapsed. The esthetician cleaned her hands with a bottle of rubbing alcohol and set it next to the client who made a sudden move and spilled it all over her chest and drape. In her haste to grab the alcohol bottle after it spilled, the esthetician knocked over the candle, which caught the draping on fire and resulted in third-degree burns for the client. As you can imagine, this was a very expensive claim to settle.

Stay within your scope of practice

One of the biggest blessings—and hazards—in skin care is constant innovation. This usually means better results for clients and a more lucrative practice for you. However, there’s a lot of confusion out there about what’s legal for estheticians to do and under what circumstances. An intelligent and well-intentioned esthetician demonstrating IPL at a trade show made the blanket statement that you can’t hurt a client with IPL. Incorrect statements such as this can lead spa professionals to become overconfident or unintentionally work outside their scope of practice. The highest percentage of claim settlements is due to scarring—sometimes permanent—caused by IPL. One such case resulted in damages of more than $100,000.

There’s also misinformation in the profession about what treatments are within an esthetician’s scope of practice under state law. It’s risky to take the word of a manufacturer’s representative who may be trying to remember the laws of 50 states, not just yours. Your state board is your only resource to be absolutely sure you are obeying the law and conducting business safely. For complete, up-to-date contact information for all 50 state boards, log on to

Minimize your risks

You shouldn’t lead your life with Murphy’s attitude, but you should know the risks of operating a spa and take steps to minimize them. If anything, the peace of mind that comes from taking precautions should make life and work more enjoyable. You and your clients deserve no less.

Jesse Cormier is executive director of Associated Skin Care Professionals (ASCP), one of the nation’s largest providers of liability insurance coverage for skin care students, professionals and schools. ASCP has more than 9,000 members and is headquartered in Golden, Colorado.

Editor’s note: This article is based on the Advanced Education Conference Program session “Risky Business—Take Simple Precautions to Keep Your Business Safe,” taught by Jesse Cormier at Face & Body® Spa Conference and Expo Midwest, which takes place March 12–14, 2011, at Chicago’s McCormick Place West. For more information, log on to



Reduce Your Risk

Avoid possible insurance claims by adhering to the following practices.

Stay within your scope of practice. Although a piece of equipment may have several uses, under your scope of practice, you may be allowed to perform just one of those functions. This should be considered when deciding whether to purchase certain equipment.

Complete forms and analysis. Make sure to fill out comprehensive intake and health history forms, and perform a thorough skin analysis before beginning any services. Do this even if your place of employment does not require it. Refresh the information on follow-up visits, and treat it as if it were Health Insurance Portability and Accountability Act (HIPAA)-protected.

Take photographs. Make it a standard practice to take before-and-after photographs of each client. Not only does this help you track your clients’ progress, it may be helpful legally should a client file a claim against you.

Buy occurrence-form coverage. Purchase occurrence-form coverage instead of the cheaper, less comprehensive claims-made insurance. Claims-made insurance expires when your policy lapses, even if you were covered at the time of the incident.

Follow directions. Carefully follow the directions for the use of your equipment and products. Do not mix products unless they are meant to be mixed according to manufacturer instruction. Have procedures in place for reporting to your manager and calling 911 if there is a concern. Always err on the side of caution.

Stay put. Do not leave clients unattended for long periods of time during treatments.

Understand your coverage. Make sure you and your staff understand what’s covered by your insurance plans—both individual and business. There are no restrictions on who can be named in a lawsuit. One case named the receptionist as a party to a lawsuit because she had booked the unhappy client’s appointment. That may sound ridiculous, but an attorney’s costs to combat even a frivolous lawsuit will probably be in the thousands of dollars.

Keep records. Keep accurate records of the treatment and products used, at least until the statute of limitations for your state expires. Back up your electronic records.

Do tests. Do patch tests even for treatments your client has had on previous visits.

Give instructions. Give complete home care instructions in writing, and have clients sign off that they have received them.

Document safety checks. Document safety checks for your equipment and practices. For example, tighten the bolts on your table at specific intervals and document that you’ve done so. This kind of record-keeping for many of your safety procedures can help you in court should something go wrong.

Be careful. Take extra care with wax pots and space heaters. Unplug your equipment when not in use. Don’t use candles or incense, period. Drapes can go up in flames and clients’ clothes can catch on fire. Use battery-operated candles or low lights. Heat sources, such as hot stones, require caution as well. Claims have been made regarding hot stones from all ages and skin types, especially older clients with thinner skin.

Build relationships. Build strong relationships with your clients. Display sympathy if something goes wrong, but don’t admit guilt. Your reaction will greatly influence a client’s decision whether to sue or not, so don’t come across as dismissive. Get pictures of the injury and document the incident in detail, keeping in mind that your documents could become evidence examined in court. Stick to the facts. Contact your insurance company immediately.

Be cautious. Be cautious about unconventional treatments. For example, estheticians have been told they can perform teeth whitening if they allow the client to insert the product into their mouths themselves, rather than the esthetician doing so. However, this can still aggravate existing dental conditions and cause burning or other problems, leaving the esthetician in jeopardy.

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